ProgenyHealth is a leading provider of care management solutions for premature and medically complex newborns. We partner with health plans and their neonatal providers to work collaboratively in developing a plan of care specific to the needs of each child - from admission to the intensive care nursery until they are safely transitioned from the hospital, through the first year of life. Our program promotes appropriate utilization, improves access, educates family members, reduces costs, and improves outcomes.

Job Role

The Case Manager will focus on empowering the members’ family to support optimal wellness while advocating for the necessary medical services across the health care continuum. The Case Manager works in a telephonic managed care setting combining strong clinical knowledge and critical thinking to facilitate a plan of care that will ensure quality medical care for the high-risk member population serviced by ProgenyHealth Inc. based on the CMSA national standards for case management practice.

• Utilizes the case management process of engaging, assessing, planning, implementing, monitoring, and, evaluating the needs of the high-risk neonatal population
• Initiating engagement with member’s caregiver during inpatient stay in order to support the treatment plan and discharge planning process.
• Acting as a member advocate by the appropriate selection of services, based upon member’s benefits, for appropriate utilization of resources, and providing an ongoing evaluation of member outcomes
• Referring members’ caregivers to community resources when appropriate and based upon client specific requirements
• Working in a telephonic managed care setting, combining strong clinical knowledge and critical thinking to facilitate a plan of care that will ensure quality medical care for the high-risk member population serviced by ProgenyHealth Inc.
• Developing care plans individualized to the needs of each infant and his/her family
• Participating in case management rounds with ProgenyHealth and client teams to discuss barriers and opportunities to improve health outcomes
• Collaborating with other ProgenyHealth staff, families, facility staff, community agencies, primary care and specialist offices to ensure that evidence-based protocols are utilized in treatment plan
• Utilizing motivational interview skills to maintain caregiver engagement through the first year of member’s life.

Qualifications

• Registered Nurse (RN) with a current, unrestricted license is required
• Three or more years of clinical experience as a Pediatric/NICU nurse or Adult ICU* is required. [* If clinical experience is Adult ICU, candidate must have experience working in a health plan in a CM or discharge planning role.]
• NICU or Pediatric Intensive Care nurse preferred.
• Five or more years of managed care experience in a health plan in a case management role is required.
• Experience with data entry into a database or EHR required. Must have strong computer skills.
• Excellent communication skills and organizational ability is required. Must be self-motivated and willing to learn multiple tasks. Must be well organized and able to prioritize tasks
• CCM certification highly desirable; and is required after two years of employment
• Ability to perform job functions with autonomy and be a self-starter
• Must possess excellent interpersonal skills, telephone etiquette and maintain positive communication at all times
• Must have commitment to excellence in customer service

Benefits/Culture

Our team is our most important asset. some of the benefits we offer our team are:

• 401K with company match
• Medical and dental benefits
• Long Term Disability
• Paid Time Off
• Business Casual Work environment
• Team orientated events throughout the year
• Role specific - partial or full telecommuting (after training period)